Unintended pregnancy is common. It is estimated that one in three pregnancies end in abortion. Management of unintended pregnancy, in the form of surgical and medical abortion, is an essential part of reproductive healthcare and fundamental for training in obstetrics and gynaecology. Comprehensive abortion care includes provision of accurate information on methods of abortion, provision of abortion and post-abortion care.

This chapter will provide background on the prevalence of abortion, pre-abortion assessment, methods of abortion, post-abortion contraception and management of abortion-related complications.

After abortion became legal in the United States, many states passed physician-only abortion laws which precluded from providing this service. Mounting evidence has demonstrated that nurse practitioners (NPs), certified nurse midwives (CNMs) and physician assistants (PAs) are safe and effective abortion providers and that patients are satisfied with their care. In recent years, several more states have enacted legislation and Attorney Generals have issued opinions allowing NPs, CNMs and PAs to provide abortion. Nevertheless, currently they are not able to provide aspiration or medication abortion in most states. Advocates are working to remove obstacles to full practice authority and the provision of abortion by NPs, CNMs, and PAs at the state and national levels. For those interested in providing abortion, obtaining education and training can also be difficult. Educational resources and other learning opportunities have been created, and new ones are emerging.

Chronicling the mid-1990s, Chapter 5 traces a debate about the relationship between abortion and health care that evolved in the aftermath of Casey. In explaining how incremental restrictions affected women’s equal citizenship, abortion-rights groups emphasized that regulations denied women crucial health benefits. In the political arena, abortion-rights advocates worked to guarantee coverage of the procedure in national health care reform, to repeal bans on Medicaid funding for abortion, to introduce legislation protecting access to clinic entrances, and to ensure access to medical abortion. In court, abortion-rights attorneys also described clinic blockaders – and all abortion foes – as sexists opposed to health care for women. Women of color offered a new framing of the relationship between health care and abortion, calling not for reproductive rights but for reproductive justice. Furthermore, Casey and the health-based offensive led by the abortion-rights movement caused some abortion opponents to lose faith in a strategy centered on the costs of abortion. To regain prominence, attorneys in groups like AUL and NRLC developed a new way of undermining Roe: If the Court saved abortion rights because women relied on it, the pro-life movement would demonstrate that the procedure damaged their health.